Drug Found to Aid Vegetative Patients

Oxygen99 writes "BBC News is reporting on some amazing effects of a drug called Zolpidem on patients suffering from persistent vegetative state. Apparently the drug, usually used to treat insomnia, activates dormant areas of the brain that can make patients aware of their surroundings and even hold conversations. This raises several interesting points including the diagnosis of PVS and the attendant ethics of the associated life support, as well as the way the brain responds to injury and damage."

Comments

Great!

[William Robinson]

Apparently the drug, usually used to treat insomnia, activates dormant areas of the brain that can make patients aware of their surroundings and even hold conversations.

Great!!! Finally they found medicine for my boss!!

FP, BTW?

Re:Great!

[RsG]

"Great!!! Finally they found medicine for my boss!!"

Nah, at a guess the drug will only work when the vegatable has a still-functional brain :-P After all, there has to be something to repair, right?

Gaba stuff

[jimmyhat3939]

It's interesting to me that these things seem to always deal with Gaba. Is Gaba the only thing in our brains?

Most anti-anxiety medications work by fooling around with how Gaba is handled in the brain. I can't remember whether they inhibit it or make it more effective. Now here you have this thing saying that people in vegitative states have something wrong with their Gaba receptors.

Maybe someone who understands a little bit about brain chemistry (if such a person even exists) can shed some light on this. For instance, does this finding imply that you could induce a vegitative state in someone by stopping the action of Gaba in their brains, only to "restart" them once they're needed again?

Re:Gaba stuff

[LiquidCoooled]

I found your hypothosis intruiging, so I went out to try it.

I could not find a simple way to stop the action of the gaba in the brains without physically removing their head (a messy procedure).

I did however find that if you remove the Gaba there is no way to restart the action afterwards.

Re:Gaba stuff

[Mostly a lurker]

does this finding imply that you could induce a vegitative state in someone ... only to "restart" them once they're needed again?

As most wives will tell you, this is eaily achieved by means of a TV remote control.

Re:Gaba stuff

[dirtyhippie]

Neuropsychopharmacology is what you speak of.

GABA is far from the "only thing in our brains". Other neurotransmitters include serotonin (important in depression and hallucinogens), acetylcholine (why people smoke), dopamine (why some drugs are addictive), (nor)?epinephrine, glutamate and aspertate, etc. etc. The descriptions of what these chemicals do, of course, is vastly oversimplified here.

As for what anti-anxiety meds do, they mimic the effect of the naturally occuring GABA neurotransmitter, and have an inhibitory affect on cells with GABA receptors.

You *could* induce a vegitative state in someone by stopping the action of GABA, but it wouldn't exactly be "persistent" - GABA helps control some rather important functions in the brain stem, like breathing and heartbeat - in short, they'd die ;)

Re:Gaba stuff

[Just Some Guy]

glutamate and aspertate

Our brain is umami and sweet at the same time? Maybe zombies are just looking for low-calorie Oriental fare.

Re:Gaba stuff

[RockModeNick]

I have found massive doses of grain alcohol in almost any form to very effectivly moderate my GABA system, and high enough a dose will indeed induce a vegitative state known as "being so freaking drunk I can't think, stand, or walk."

Perfect for IT

[s0l3d4d]

A person in a vegetative state will appear to be awake and may have their eyes open, but will show no awareness of their surroundings.

They will not be able to interact with other people, and will show no responses to sounds or things that happen around them.

But they will show signs of movement, and cycles of sleep and may be able to breathe on their own.

So what would happen if they would start to give these drugs to technical support people and system admins? Would they also start to show responses to their environment, and manage to hold a conversation?

Important distinction

[fsckr]

PVS is not brain death. The two are completely different and unlike the parent post implied, very few families would consider pulling the switch on a patient's with PVS. Patients with PVS react to pain and other extreme stimuli, so cutting off their nutrient supply is tantamount to starving them to death.

"PVS is also known as cortical death, although it is not the same as coma or brain death."

As opposed to brain death, PVS is not recognized as death in any known legal system.

- wikipedia article

Re:Important distinction

[Oxygen99]

This distinction wasn't considered important in the case of Tony Bland, a PVS patient who was allowed to die in the UK several years ago. Although it isn't recognised as brain death, in this instance doctors allowed the feeding tubes to be removed, effectively, as you say, starving him to death. In the UK at least, it seems the two are usually equated.

Re:Important distinction

[Viol8]

"Her parents desperately fought to keep her alive, because she could make sounds, move her limbs, keep solid eye contact on someone"

So can an ant. It doesn't make them human. If the personality is gone
and theres no sign of intellect all you have left is a base functioning
brain.

"It was downright horrible and state approved MURDER."

In your opinion. Perhaps if you'd been her husband you might have a
different opinion. You sanctamonious types are all mouth. I'd love to see
one of have to see your wife be a vegetable for years or even decades
and see if you still have your arrogant self righteous opinions then.

"Ths drug could have helped her have a normal life, but she did not live long enough to ever have the chance to try it!"

And many people in the middle ages died because they couldn't wait 500
years for anti biotics to be invented. So fscking what?

Re:Important distinction

[FidelCatsro]

Shockingly enough , and this may seem insensitive to say so but it makes a point.
Did anyone ask the patient in question about it.
So if they are brain dead then it is nothing to worry about and simply allowing the family to finally grieve .
If they are not brain dead, then can you imagine being in a PVS , unable to move , do anything for yourself , interact . A veritable life sentence in solitary for the innocent.
To me , letting someone die seems far far less cruel than that.
If there is now medicine which may help some people recover , then that is wonderful but sometimes there is nothing you can do for someone.

Re:Important distinction

[Richard_at_work]

How long should they have kept her alive artificially? Until her parents had died? What then? Who makes the decision after that point? She cant afterall die naturally, the doctors could always keep the body functioning well past a normal lifetime, so when should treatment be withdrawn to allow her to die?

Point is, she was being kept alive artificially, she could not communicate and she showed no signs of intelligence. Her brain patterns were nowhere near normal. In these situations, people will believe out of desperation any little grunt or sniffle is an attempt to communicate.

All of the evidence presented by the postmortem showed that the husbands case was proven - she had no brain function to speak of.

Re:Important distinction

[hackstraw]

And many people in the middle ages died because they couldn't wait 500 years for anti biotics to be invented. So fscking what?

Westerners have an irrational fascination with these new drugs and yes, they do prolong life, but quality of life is most of the time in no way shape or form improved. I've seen family members whose bodies have basically failed, but the doctors have kept them physically alive for another couple of years, for nothing, at the cost of between $10,000-100,000 a piece.

I've been a victim of the FDA approved drug bullshit for almost 20 years, and now that I realize that the drugs made me worse over the years, which has been supported by medical studies, I'm off of the drugs, and at least for now, I'm fine, and I feel healthier than I have in over 20 years since before I started taking these things.

I will give western medicine 4 things. 1) Improved success in living for mothers and children during child birth. 2) Physical repair of broken things like hips and joints. 3) Improved quality and longevity of life because of antibiotics. 4) Immunizations for nasty things.

I'm sure that someone will add to the list, and I did not come up with that list via hard hours of research, its just one I've put together over the past few months of thinking about the stuff.

I was labeled as being mentally ill when I was 18, and have taken between 8-10 different maintenance drugs to help me "manage" my condition. Well, between 6-8 of those drugs are documented for making me worse, which is what I said word for word the last time I saw my doctor. So, he gave me another handful of drugs, that I never took and I threw in the trash. I have altered my diet, and am taking quality (read, not Centrum or anything like that) vitamins, herbs, and supplements, and I'm essentially symptom free, and I have had friends and coworkers comment on how much better I seem.

The drugs that were given to me gave me 1) Chronic diarrhea for over 18 months 2) Headaches 3) Vertigo to the point of almost getting in serious car accidents twice. 4) Depression, anxiety, confusion, and mania (what the drugs were supposed to treat) 5) Obsessive thoughts, usually in the form of a cheesy pop song that I could not get one line out of my head. 5) Daily dry heaves. 6) Paranoia 7) Generally a lower state of cognition and well being.

Oh, and if you think all of those things don't affect your personal and professional life, well, in my case they did.

The trend here is for the pharmaceutical companies to make "maintenance medications", not a cure or something that will drastically increase the speed of recovery and then forgo taking the drug. I strongly recommend that nobody take a drug that is prescribed by a doctor that has no time frame for when you are to stop taking the drug. At least, do plenty of research, and get second and third opinions before taking any maintenance drug.

Another thing to look into, is what you are eating. Most of the food in this country is either void of nutrients or has additives or pollutants in it or comes from unhealthy, uncared for animals. This is for another discussion.

Re:Important distinction

[Loquax]

onevulcanme-- As a Catholic who agrees with your desire to see all life cherished and preserved, I agree with your sentiment, but as a person who values logic, reason and most importantly, the law, I have to point out a few things. First, Mr. Schivo was given guardianship of Terri by a court of law. You and I may disagree with the judges decision, but we have to respect the law. I prayed daily for that Michael would reverse his stance and hand guardianship over to her parents, but in the end, he exercised his rights under our legal system. If you don't approve of that, cool, but in the end, in this case, it was nobody's decision but his that mattered. Second, as a pro-life Christian who also believes that it is wrong to bear false witness against another, I am embarassed and hurt that people chose to villify Michael Schivo. I understand her parents were not happy with him, I understand that emotions (and not reason) guide any parent's wishes for a terminally ill child, but the rest of us should have taken a step back and realized that none of us had any business judging the man. Have whatever opinion you like, but don't judge a man evil or damned in the eyes of God. We as Christians are forbidden to "judge" (in the sted of God) another, nor are we to slander a man. Michael Schivo was accused way after the point by Christians of beating her to death (way beyond what the scientific proof held), of being a money grubber looking to get his hands on her cash, and of being evil. I saw several interviews with Michael Schivo, and I felt (and still feel) that he was a man plauged by a complicated situation who acted out of love for a woman he made a promise to long ago. God only knows what was truly in his heart, and I hope and pray that it was good intent. The more Christian way to have handled this would have been to leave the man alone with his charge, his wife, and pray for him, and later petition our legislatures to assume a pro-life stance of preserving life in questionable situations such as these. It should be assumed that in absense of a living will or final directive that the person wanted to be preserved. I'm sure it would have been a relief to Michael Schivo to know that the decision was out of his hands in the case of questionable desires from Terri. I personally have written out a living will that directs my wife and thoes I love to take specific actions and filed it with a lawyer. I encourage everyone who feels one way or the other about the sanctity of life and the meaning of death to do the same, but for God's sake (litterally) make up your mind about what life and living mean to you and take a stand.

Re:Important distinction

[SatanicPuppy]

My mother recently died in a similar manner; she was non-responsive, but not brain dead, and I asked that tubes be removed. She had zero chance of short-term meaningful recovery, and the long term was terminal brain cancer (the survival rate 96% of healthy patients her age was 2-6 months. The other 4% were dead in 10 months). She left very specific instructions regarding this possible eventuality (they included the words "Get Dr. Kervorkian"), so there was little debate from the rest of the family (none from the doctors).

I think you'll find that most patients die of pneumonia brought on by the morphine, and not by starvation. I sat by her bed for 10 days, and I can vouch for the level of comfort provided by the physicians...if her body showed any signs of distress, and we're talking elevated heart rate here, they took steps.

It is only a cruel way to die for the people who have to watch.

Re:Important distinction

[localman]

You sanctamonious types are all mouth.

I'd have to agree with this. Members of my own family flipped out over the Terry Schiavo thing, calling it murder. And this was after they had pulled the plug on my grandmother for being in a similar state after a stroke. This was back in '91 and she was in PVS for only a couple weeks. All I had to do was remind them and they shut up. Around me, anyways... they'd still go on preaching to others who didn't know they had made the same decision for their own loved ones.

Cheers.

Re:Important distinction

[plunge]

Tom Delay, of course, before the controversy began and he put himself at the forefront of it, pulled the plug on his own comatose father.

The problem with the extreme pro-life position is that they don't really believe their own rhetoric when it comes to actually applying it to real situations affecting THEM instead of other people they can just rail against. Given the choice between saving a billion zygotes and a single human child, they'd all save the child, and they know it. For all the talk about killing zygotes being murder, or morally equivalent persons no matter what stage of development they are, they don't really believe it. Even the group of brothers who supported the Schiavo parents had basically allowed their own founder to die when they could have kept his body alive just like Schiavo's.

Re:Important distinction

[mdielmann]

I'm currently on what you called a "maintenance drug" for a long-term condition. I'm getting the results expected for the drug, with none of the side-effects (which can be bad). I've had varying qualities of diet and lifestyle over the duration of my condition while I wasn't taking medication and, while my symptoms were lower when my lifestyle was at its best, I've never felt as good as I do now. It's worth noting that my lifestyle is currently at a poorer state, close to the typical North American's.

What I'm getting at is that I agree with you, to a point. Like anything else, take the least invasive approach to solving a problem, so long as the problem is solved. Fortunately for you, that was merely (merely!) an overhaul of your lifestyle. Less fortunately for me, it may be a lifetime of medication. But frankly, if the improvement is as dramatic as it has been, that's a price I'm willing to pay. Not that I'm unwilling to see what difference a lifestyle change can add to (or maybe even replace) it.

Re:Important distinction

[localman]

Yeah, my family revealed themselves on that one, too. After years of being vehemently pro-life, someone in the family had an abortion (not medically necessary) and they all found ways to justify it so they wouldn't have to condemn the person. It's paper-thin morality. And they haven't learned a thing from either experience or fessed up. Don't know what to do with people like that except ignore them. Which is hard when it's your family :)

Cheers.

Re:Important distinction

[tgibbs]

Unfortunately, there are many conditions where none of the available drugs are entirely satisfactory. In psychiatric illnesses, especially, some people respond to one drug and not another, and some people find the side effects of one drug intolerable while others have no difficulty. Psychiatric illness is still poorly understood, but it's suspected that psychiatric illness can arise from multiple causes, and at present there is no good method other than trial and error to identify the best treatment for a particular individual. Current medications are largely derived from trial-and-error experimentation, because it is difficult to develop good animal models for psychiatric illness. Without a better understanding of how these illnesses arise, true cures, as opposed to palliative medications, are unlikely to arise.

Re:Important distinction

[SatanicPuppy]

I have a living will which says, that if I'm in a persistent vegitative state with no reasonable hope of recovery, I want my loved ones, or the goddamn government, to pull the plug. Because, at that point, I don't call it living.

My mother had the most straightforward approach to dying of anyone I've ever seen. She found out she had a tumor, she went out and got a living will and a medical power of attourney, and she gave them both to me and specifically told me under what circumstances I was allowed to put her on tubes. And by God I did exactly what she asked. She met her death with courage and dignity, and she trusted me to make that possible for her, and not to stick her on those goddamn machines.

And I don't need some filthy little quasi-moralistic cocksucker who has no fucking idea what he's talking about DARING to give me shit about it. I hope to God you end up trapped in a rotting shell of a body by your own goddamn living will that forbids anyone from touching your precious precious tubes.

Re:Important distinction

[Keebler71]

I was labeled as being mentally ill when I was 18, and have taken between 8-10 different maintenance drugs to help me "manage" my condition. Well, between 6-8 of those drugs are documented for making me worse, which is what I said word for word the last time I saw my doctor. So, he gave me another handful of drugs, that I never took and I threw in the trash. I have altered my diet, and am taking quality (read, not Centrum or anything like that) vitamins, herbs, and supplements, and I'm essentially symptom free, and I have had friends and coworkers comment on how much better I seem.

Quite a rant about the state of pharmaceuticals... have you considered breaking out Occam's razor? Perhaps you're original diagnosis was wrong and you've been fine all this time? That would explain why the meds made you worse and also explain why something as simple as diet modification worked.

Re:Important distinction

[cellocgw]

Approaching child birth as a desease that should be treated at the hospital is wrong and is entirely a Western invention.

Since I have direct knowledge of cases where women chose to give birth at home, resulting in the death of their child due to simple, easily treated problems like myconium inhalation, I have no misgivings about calling you an uneducated fool.
Childbirth is not considered a "disease," but it is considered a potentially dangerous situation both for mother and infant.
Another case: woman with failure to completely expel the placenta starts a major bleed. Hospital care saves her easily. Try doing that at home.

Re:Important distinction

[Lord Ender]

You were on meds because you are crazy. Modern western medicine is tested scientifically. The fact that you had bad side effects from some drugs is NOT scientific at all. The fact that you think careful vitamin use cured all your ills is NOT scientific. If it did cure you, you were probably malnourished, and the only person you have to blame for that is yourself (not "society" or whatever). Our society requires nutrition info to be labeled on food. Nice, eh?

You are right that psychology is one of the most difficult parts of medicine. It is hardest to study scientifically, and hardest to diagnose.

Most "western" medicine is FAR more precise than psychology. I take some very expensive maintenance medicine, and if I took your advice, my life would be MUCH worse. Without western medicine, I would be crippled by allergies, I would be bald, and I would have life-changing digestive problems. No herbs would change that. You show your insanity for suggesting so. Taking pills every day is much better than the alternative.

Re:Important distinction

[Alsee]

I'm really afraid of people like you.

You're afraid of someone who went through the pain and suffering of faithfully following their loved one's last wishes?

I'm afraid that when time comes they will lie ... and expressed wisshes opposite to my real ones.

That's pretty pathetic if you can't find a single trusted loved one to home to give power of attorney for such cases. I sure as hell hope you're not married.

-

I've always found that...

[Anonymous Coward]

Salad dressing always seems to bring my vegetables to life.

*cue cricket cheeps*

What?

Re:Oblig. Terri Schiavo comment.

[smcavoy]

the autopsy showed she was a vegetable and not just in a vegetative state.
She died years ago.

Re:Oblig. Terri Schiavo comment.

[pedantic bore]

Pull the plug too early? Her husband would say "we" waited many years too long...

According to the autopsy, this drug would have had to have done a lot more than described here. Maybe if they'd given it to her when she first fell into a coma (we'll never know) but by the time she died, her brain was irreperable.

Re:Oblig. Terri Schiavo comment.

[RsG]

I seem to recall that her autopsy found what was essentially mush where her neocortex would be. I would tend to guess that that kind of damage really is irreparable - but IANANeurologist, so I don't know for sure.

Assuming we could fully repair braindeath (ie, restore the brain when higher functions have been lost), what would remain of the original person? Would we have an adult with infantile brain capabilities, a blank slate? How much of a person's identity is hardcoded? And what are the ethics of the situation - do we revive someone knowing that we'd be making them start over from scratch (and maybe not even that - most of early learning is made possible by infantile brain "plasticity", which an adult brain lacks).

It's not an easy question...

just kill me

[m874t232]

If my brain has been damaged so much that I can only be roused to awareness of my surroundings by a drug that artificially and temporarily activates bits and pieces of my brain, I just want to die quickly and painlessly. As far as I'm concerned, the biggest crime against me would be to keep me alive.

Re:just kill me

[aadvancedGIR]

I really agree, beside dignity issues, there truly are states worse than death. Too bad most doctors consider one more day of agony a great victory.

Re:just kill me

[Itchy Rich]

If my brain has been damaged so much that I can only be roused to awareness of my surroundings by a drug that artificially and temporarily activates bits and pieces of my brain, I just want to die quickly and painlessly. As far as I'm concerned, the biggest crime against me would be to keep me alive.

You say that now, but if it were to actually happen to you I very much doubt that you'd rather die than be dependent on that drug.

It's like all the people that say they'd rather die young, and can't stand the thought of growing old. When it actually happens to you and you're faced with the prospect of death you'll change your mind pretty fast.

Re:just kill me

[FlopEJoe]

If my brain has been damaged so much that I can only be roused to awareness of my surroundings by a drug that artificially and temporarily activates bits and pieces of my brain...

Eh? Sounds like my morning coffee after a night too much cheer! (not to make light of folks with real mental distress)

Re:just kill me

[MBGMorden]

That's nice to know. Be sure to tell them that on your first awakening so that they can carry our your wishes afterwards.

That fact bears nothing on the usefulness of this drug though, as it's the lone opinion of yourself. Others may (and probably do) share that viewpoint, while still others will not. There are plenty of people who very much would like this, and as such it's a worthy pursuit.

Re:just kill me

[RonBurk]

> If my brain has been damaged so much that I can only be roused to
> awareness of my surroundings by a drug that artificially and
> temporarily activates bits and pieces of my brain,
> I just want to die quickly and painlessly.

You want to die if we run out of coffee? Geez.

Re:just kill me

[vertinox]

So hey, why not wait a few more years and risk being "revived"?

Judge: "All in favor of waiting a few years of being alive say "Aye""

Doctors, Nurses, Lawyers, and Culture of Lifers at the bedside: "Aye!"

Judge: "All those opposed... Say "Nay!""

Patient: "..."

Judge: "The "Ayes" have it!"

Re:just kill me

[YoungHack]

> You say that now, but if it were to actually happen to you I very much doubt that you'd rather die than be dependent on that drug.

> It's like all the people that say they'd rather die young, and can't stand the thought of growing old. When it actually happens to you and you're faced with the prospect of death you'll change your mind pretty fast.

That's totally true. Having watched my (young) wife go through stroke, I have to say that living wills make very little sense. You cannot predict while you are perfectly healthy and sitting at the kitchen table what choices you'll want when something happens.

As it was, she refused treatment for a while and changed her mind later. Hard choices came day to day. More than once I believed I had made the hardest decisions my life would contain, only to be wrong the next day.

I think the most useful document is a durable power of attorney document. Find someone you trust, who loves you (more important than the other way around). Talk about things some ahead, but tell them to make the best choices they can.

It may mean a mistake. They might act to save your life when they shouldn't. Or they might act to let you go when they shouldn't. But at least they will be making the decisions with the information available then, when it counts. It's better than you can do in a living will.

but...

[Shivetya]

does it work on managers?

Cool, but...

[MWoody]

This is great news, and fascinating from a technical standpoint. But I cringe to think of the unfortunate side effect of something like this: think of the countless grieving families who, on the advice of their doctors, pulled the plug. Particularly those who did so recently. Imagine the horror to imagine that this drug could have brought their loved ones back.

I'm not saying that the decision not to perpetuate the incurably brain dead is the wrong one, nor am I placing blame on the medical community in any way. But you can't expect laypeople to understand the difference, really, and the pain of not knowing if the decision was the right one... Of constantly wondering, down where logic doesn't really help, if there was a chance...

Re:Cool, but...

[RsG]

Well, to point out the obvious, long term PVS leads to degradation of the brain. In the Schiavo case that's being brought up in this thread, what remained of her brain had severly atropied, and much of the higher brain centers had been replaced with spinal fluid.

If someone's family memeber were brain dead, then waiting for a miracle cure might not be an option. After all, if it takes ten years for even a partial cure to become available, then that's ten years in which the afflicted is slipping further and further away. This sort of drug might help someone who gets hit by a car tommorow, but it probably won't do much good for someone who got hit by one years ago and has been dead to the world since.

Re:Cool, but...

[plunge]

As we get more and technologically advanced, these what-if questions will always come up, and it's important to be serious about it.

If we develop the technology do bring a truly dead person back to life: to re-animate a day old corpse, will cremation be murder?

Or take the Schiavo case: it may one day be possible to insert new brain cells into someone like that and have them get up and be a person again. But they may not be the same person: the old brain matter that held their memories and personality may be gone. And yet, since we can do that, should we never pull the plug on a brain dead person?

What makes you, you? And what rights do YOU have in determining whether medical science can essentially keep your body alive, forever, no matter what happens to that "you?"

Exciting... but unproven.

[Puls4r]

Aside from the obvious issues here of a very minimal sample size, it sounds like some doubts have been raised as to the accuracy of the original diagnosis of persistent vegetative state (PVS).

We understand very little of what causes a person to shutdown and go into PVS. As such, it is EXTREMELY hard to truly diagnosis and pinpoint what is going on. Normally, we wait. If they wake up, it wasn't PVS.

This is like a myriad of other diseases like SIDS that are vaguely defined. Many more incidents are attributed to the issue than are actually caused because we simply don't understand it.

Hyperactivity disorders in children are another perfect example of a rather subjective diagnosis leading to over-prescription and misunderstanding. All that said, hopefully another set of trials over a wider base of patients proves some hope. (insert the obligatory Robin Williams "awakenings" quote here).

Re:Terri Shivo

[vandan]

No. Terry's cerebral cortex had completely disintegrated. There was nothing to re-activate. No amount of praying or injecting or stimulating her could have changed the fact that her brain was simply no longer capable of higher-level thoughts, as the part responsible for such thought had 'turned to jelly'.

It's not news yet

[hey!]

until it's been replicated and the results published in a peer reviewed neurology journal.

Over the years there have been miraculous cures for diseases that didn't pan out because they couldn't be replicated. Reasons for this might be: the study patients weren't really cured, the study patients improved, but didn't have the disease in question, scientific fraud, simple chance. This is the kind of result that has to be looked at skeptically, because if it were true, it would be true it would mean the bulk of what we think we know about the brain and its function is wrong.

It's possible, of course. Such possibilities are part of what makes science and exciting pursuit. It's also possible that the authors didn't do their study correctly. It's your choice as to what is most likely. If I had to bet, it would be the study population was not selected properly (i.e. they were in a coma, but not a PVS).

I checked out the journal in question. It is peer reviewed, but it is not a neuroscience journal per se. It is an interdisciplinary for various disciplines involved around rehab of brain damage patients. Although it's perfectly erspectable to publish in such a journal, the article would have a lot more initial credibility if it had been published in a journal specializing in basic neuroscience research. It would have to convince reviewers who would be forced by the publication to admit that they hold some significant misconceptions. It's a tough standard of truth, and it slows the spread of Truth (if you will), but it slows the spread of Error more.

If this is a legitimate result, the publication activity will be, to borrow a metaphor from Shaw, like the first pea in a handful of peas thrown at a wall: first one hits, then a couple, then a whole mass of them. Afterwards, the state of science will have changed in a fundamental way.

Re:It's not news yet

[ChrisMaple]

News is precisely what this is. By the time it's become an established fact or established medical practice, it's long since stopped being news. Even by the time it's been replicated and published in the appropriate journal, it's fading from the news scene, although each new publication is a separate news item. The root of the word "news" is "new".

Re:Oblig. Terri Schiavo comment.

[clickclickdrone]

For those that didn't bother to read the medical reports and instead relied on the newspapers/media, Terri's brain had totally atrophied away, it was gone. Her skull contained the brain stem, a bit of shrivelled brain and an awful lot of fluid. There really was no hope, she was long gone.

What simple questions?

[suparjerk]

It'd be cool to know exactly what "simple questions" were asked and what their responses were. My definition of a "simple question" might differ from theirs. Even if they had asked /complex/ questions, that doesn't necessarily mean the answer was correct or even intelligible.

Researcher: Hi there, can you see me? Patient: FFOOOOOOOOOMDE!

Sure, they interacted with the researcher and they answered a simple question. Their response could even arguably be considered a word, perhaps poorly pronounced, but... I fear the article leads this discovery to sound more amazing than it actually might be.

Re:What simple questions?

[Tx]

I was wondering the same thing. Like did "catch a basketball" mean a basketball thrown from across the room with the patient standing up, or dropped into his arms from a couple of inches with him sitting down. It's the usual frustrating lack of detail we get with mainstream media reporting of science issues. I understand they want to keep it simple, but make it too simple, and the report becomes almost meaningless.

Re:What simple questions?

[KarmaMB84]

It's probably more like
Researcher: Hi there, can you see me? Patient: BRAAAAAAIIIIINNNZZZZZZZZ

Re:What simple questions?

[inKubus]

Well, gathering from the article and a few other posts:

There are two sides of the brain, the conscious and the subconscious, with a sort of database in the middle. The conscious mind is associated with meaning, emotion, deep thoughts. The subconscious is associated with motor skills, communication, and logical thoughts.

There's a collection layer that handles getting data from your senses (eyes, ears, nose, etc.). The conscious mind is what you use for memories. It handles tagging data with meaning before it's inserted into the database. If there is no meaning, it cannot be retrieved from the database. More on this in a second.

The subconscious is the section that's responsible for acting on things. You know how sometimes you just "get that feeling"? That's when you are sort of aware of your subconsious working. Your subconscious has read access to the database, so it can draw on all the stuff in there to run your body, even if you are no longer learning (conscious tagging and assigning meaning to sense data).

Ambien turns off the conscious mind and actually stimulates the other sections. So you hear stories of people on Ambien running tractors or cooking breakfast in their sleep and then having no recollection of it. Their subconsious mind is easily capable of performing these tasks, it can just refer back to the thousands of other times you've walked or driven or cooked eggs.

So, in people who's brain is damaged in such a way that their subconscious faculties are still working somewhat, if you stimulate what is still working, you can get a reasonable facsimile of a healthy person's behavior, as far as logical tasks are concerned.

But all this really does is explain why Ambien is a really really bad choice for a sleeping medication. I mean, it activates your mind and body but turns off it's ability to record. You are, in essence, a zombie.

Starving...

[electrosoccertux]

If she was dead, why not use a faster means of death? Like lethal injection or something. We wouldn't cruelly starve an animal to death. I think that would have been too quick; would have looked too much like murder (as if starving her were any better). It's odd that the painful of treatements was the more socially acceptable.

Re:Starving...

[Doc Ruby]

Because the same groups of theocrats trying to pray Mrs Schiavo's brain back from the dead have actually succeeded in thwarting America's euthanasia movement. Even people who face an horrible, immediate terminal condition ("certain agonizing death") with determination to spare themselves and their family the fear, pain and expense with dignity can't get help to kill themselves quickly and painlessly. Because America's Christaliban has already got more political power in shaping the laws.

Instead, "Compassionate Conservatism" demands people get tortured medically as long as pharmacos have a legal patient. When Republicans need political lifesupport, they'll move heaven and Earth to invade people's privacy even to interfere with what little protection we have for letting a dead person's body join them after a decade of medical and legal consensus.

Re:Starving...

[KarmaMB84]

Because eventually another family member with something to gain ($$$) from their death will gain the power to make medical decisions and argue they have the right to have them euthanized. I'm an atheist and I think the prospect of having people euthanize other people is horrendous. Abuse would be inevitable and you can't trust the courts not to throw out any provisions to stop the abuses.

Re:Terri Shivo

[jonnythan]

No, according to the autopsy.

The brain itself weighed 615 g, only half the weight expected for a female of her age, height, and weight. Microscopic examination revealed extensive damage to nearly all brain regions, including the cerebral cortex, the thalami, the basal ganglia, the hippocampus, the cerebellum, and the midbrain. The neuropathologic changes in her brain were precisely of the type seen in patients who enter a PVS following cardiac arrest. Throughout the cerebral cortex, the large pyramidal neurons that comprise some 70 percent of cortical cells--critical to the functioning of the cortex--were completely lost.

The damage was, in the words of Thogmartin, "irreversible, and no amount of therapy or treatment would have regenerated the massive loss of neurons."

Re:Oblig. Terri Schiavo comment.

[demonlapin]

Do we consider a person dead if the human aspect (the conscious mind) is gone?

A private service by me to all of Slashdot who doesn't understand:

Brain death is defined legally as cessation of all brain activity, with the caveat that it is not due to a reversible cause. Brain dead people are, simply, legally dead. While we generally leave someone on ventilators and the like for a short period of time after brain death, because families often feel like death is when the heart stops (and they want to be there), there is no legal requirement to do so. Once a diagnosis of brain death is made, I can fill out a death certificate and turn off all the machines.

PVS is not the same; PVS patients have some brainstem activity but no evident higher function.

So, to answer your question, no, we don't. But you probably wouldn't want to live like that.

Re:Oblig. Terri Schiavo comment.

[RsG]

I don't know whether that plasticity would return or not. Actually, if we could restore a braindead person, then giving them back all the mental maeliability they had as an infant would probably be trivial. The real pain would be rehab; imagine trying to re-teach everything - absolutely everything - a person learns in their childhood all over again.

As for the pruning thing, that is a very interesting question. I guess we could probably do it if we could pull off all the other miracles we're talking about in getting a braindead person healthy. The problem might be testing it - this is not the sort of thing you can easily test on animals, and the ethical problems with human trials would be a big hurdle.

The funny thing actually is that if we had the techology to cause neurological plasticity and neuron pruning, we'd probably ban it, fear it, or at least put heavy restrictions on it, given the abuses that could come out of it. Can you imagine what a totalitarian government would do with a way "reeducate" dissidents? We've already got people up in arms over GM tech, stem cells and human cloning, and those are all relatively minor by comparison.

Re:NOOOO!!!! TERRYYYYYYYYYY!!!!!!!!!!

[narcolepticjim]

It's unlikely anything would have helped her. The sheer amount of brain tissue that died as the result of her cardiac arrest probably precluded any treatment for her.

Re:Terri Shivo

[R2.0]

"Otherwise he could simply have divorced her and moved on with his life."

No, he couldn't.

Terry was legally incompetent to participaet in divorce (or any other) proceedings. Normally, this wouldn't be a big deal - just have her legal guardian represent her. Problem - her legal guardian was Mark. Mark couldn't try to divorce her - he'd be representing her against himself. It only became an "option" when her parents "offered" to take over her guardianship in a quid pro quo - he relinquishes his responsibility to his wife in return for not contresting a divorce.

Mark was Terry's legal guardian because she CHOSE it before she died, by marrying him. Her parents couldn't (and probably still can't) get that through their heads. They went to desperate lengths to override their daughter's wishes, denying her the very autonomy and choice she had made previously. She chose to leave them and put her care into the hands of another. Mark did the same thing - it's called marriage.

Mark discharged his responsibilities to his wife. Why couldn't her parents accept that?

Bah

[dumdeedum]

Drugs to aid vegetative patients is ridiculous when you can simply cure them by feeding them meat.

What is the matter with me...?

[dkf]

I read that article title and immediately wondered if the researchers were using BabyBio or MiracleGro...

This might help my daughter - more info?

[dzogchen]

My eldest child has an undiagnosed condition that has left her unable to walk, talk, move, eat etc. The condition developed gradually and doctors say that the problem seems to be in the brain stem. I gather that GABA affects the working of the brain stem.

Does anyone have a link to the actual paper, or more info on this? I hesitate to grind up an Ambien and put it in her G-tube, but even the thought of something that might help her brings tears to my eyes as I write this. You have no idea what it is like to watch your child essentially disintegrate right before your eyes -- it's been 18 years of torture.

Thanks in advance for any help.

Re:This might help my daughter - more info?

[nbritton]

"Does anyone have a link to the actual paper, or more info on this? I hesitate to grind up an Ambien and put it in her G-tube, but even the thought of something that might help her brings tears to my eyes as I write this. You have no idea what it is like to watch your child essentially disintegrate right before your eyes -- it's been 18 years of torture."

Try it, if you can get your hands on some. Ambien is a fairly mild drug in my book... read up on the prescribing information sheet and try it on yourself first to test for allergic reaction (rare) etc. Ambien CR is supposed to be a longer lasting version of this drug, the half-life for normal ambien is like 2.5 hours... BTW.. I'm not a doctor, but I did stay at a Holiday Inn Express last night :-).

Every time I've taken this drug, for sleep problems, I get amnesia from it. The best example I have for this was when I was in the hospital and was given this drug to help me sleep for the night, the nurses said I was up all night reading magazines when I 'knew' I had fallen asleep... I have also witnessed this side effect in other people, she was able to cook a meal on the stove and have a conversion with me but had absolutely no memory of this event, It's a common side effect for this drug but they like to down play it for sales... This I'm sure has something to do with the topic at hand...

Re:This might help my daughter - more info?

[johansalk]

TALK TO YOUR DOCTOR FIRST before you try anything. You don't know for sure what effect it may have on her breathing and such.

Oblig. Brain/Computer Analogy

[Kadin2048]

Back when the Schiavo thing was going on, somebody made what I thought was a reasonably apt computer analogy. I'll paraphrase as best I can (and apologies to whoever originally came up with it).

Being comatose is like a computer crashing. It can happen for a variety of reasons, hardware (injury) or software (psychological), and sometimes it's fixed by letting the system reboot itself (persn sits there until they wake up).

PVS is a lower-level issue. It's like having a device get bricked because the firmware gets hosed. Some low-level stuff might work, and the hardware might or might not be okay, but nothing's running on it.

The Schiavo case was like opening up a computer's case, and realizing that somebody's stolen the CPU, RAM, and motherboard, and replaced everything with the contents of the small-electronic-parts drawer at Radio Shack. You can try to reboot or re-flash that thing all you want, but it's never going to come back on.

I'm sure there's probably a bad car analogy in there somewhere, too.

Re:This could be an amazing discovery!

[pwntang]

I don't know, that chick from Kill Bill seemed ok after her coma

Let's never talk of this again

[spun]

Or anything else that might offend anyone, anywhere. The most important thing is to put on a happy face and never disagree. Just nod and smile, there ya go, uuuhhh, let me wipe that drool off your chin...

Seriously, wtf? Just because an issue is controversial we can't talk about it? What kind of PC thought policing happy-happy joy-joy troll ARE you? Me, I only read the flamebait articles. Sure, there's lots of immature asshats, but the amazing thing is, on any issue with any kind of controversy, you also get plenty of thoughtful and interesting arguments from both sides. Which lets you strengthen your own arguments by responding to criticism from intelligent people. It's a little technique known as dialectic, you may have heard of it.

Re:Oblig. Terri Schiavo comment.

[molo]

Couldn't they have done an MRI while she was alive and found this? Or maybe a Functional MRI? I don't understand why this wasn't detected earlier.

-molo

Re:Oblig. Terri Schiavo comment.

[brouski]

They did do a CAT scan in '02 that showed severe cerebral atrophy.

All I am going to say

[majortom1981]

I know from real life experiences that some wierd things can go on in regards to comas.

I was in a coma for 5 weeks and woke up like nothing was wrong.

I also was in another one for a week. They had me on life support and everything. They didnt expect me to live.One day i woke up like nothing happened.That night I was complaining that I wanted to go home.

The mind still holds a lot of secrets.

I still have doctors who want to stick me in a hospital and run tests for months.

The medical study, and this isn't the only drug

[Frangible]

Effect of zolpidem on brain injury and diaschisis as detected by 99mTc HMPAO brain SPECT in humans.

The study investigates the effect of zolpidem (CAS 82626-48-0) on brain injuries and cerebellar diaschisis. Four patients with varied brain injuries, three of them with cerebellar diaschisis, were imaged by 99mTc HMPAO Brain SPECT before and after application of zolpidem. The baseline SPECT before zolpidem showed poor tracer uptake in brain injury areas and cerebellar diaschisis. After zolpidem, cerebral perfusion through brain injury areas improved substantially in three patients and the cerebellar diaschisis was reversed. Observations point to a GABA based phenomenon that occurs in brain injury and diaschisis that is reversible by zolpidem.

The problem with this study is a small sample group and no control. You can't make many broad conclusions from that data.

Indications, efficacy and tolerance of drug therapy in view of improving recovery of consciousness following a traumatic brain injury

... RESULTS: The synthesis provides evidence about the theoretical actions and efficacy of the available pharmacological agents. The clinical studies are less convincing: indications and therapeutic choices are empirical. Studies report often single cases. Randomised studies are rare, often heterogeneous concerning the aetiology of the brain lesions. The evaluation scales are varied and too wide. In this context, amantadin, amphetamine, methylphenidate and bromocryptin showed some positive effects. ...

All of the drugs described in the above study have dopaminergic function; either indirectly increasing dopamine levels (amantadin, amphetamine, and methylphenidate) or directly agonizing the receptors (bromocriptine). It is interesting that GABA, an inhibitory rather than excitatory neurotransmitter in most cases, shows efficacy here as well.

Worst web site this month

[Beryllium Sphere(tm)]

To save you frustration: Volume 21 Number 1/2006, pp. 23-28
Try, with low expectations, http://tinyurl.com/e6wgz or http://tinyurl.com/krr39
There's a "free sample issue" button. Unfortunately it goes to the January 2004 issue. The actual article is at http://tinyurl.com/h6f79, USD20 for online pay-per-view.

Zolpidem/Ambien

[nincehelser]

I suppose it depends on the patient's current condition and dosage, but my experience with Zolpidem (Ambien) is that it really messes with your head, particularly your memory. So, if it brings somone out of a vegatative state, will they be able to remember it? It might make them more communicative, but what's the point if you can't retain the memory?